Provider Demographics
NPI:1013075803
Name:BRISENDINE, LEONARD ANTHONY (LPC)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:ANTHONY
Last Name:BRISENDINE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 S WASHINGTON ST
Mailing Address - Street 2:#318
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4406
Mailing Address - Country:US
Mailing Address - Phone:202-236-0911
Mailing Address - Fax:
Practice Address - Street 1:1717 K ST NW
Practice Address - Street 2:SUITE 600
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5346
Practice Address - Country:US
Practice Address - Phone:202-236-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13861101YP2500X
VA0701003387101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional